Interpersonal and Community-Level Influences Across the PrEP Cascade Among Young Adult Latinx Men who Have Sex with Men Living in a US-Mexico Border Region: A Qualitative Study.

Latinx men who have sex with men (MSM) are an at-risk population for new HIV diagnoses. Pre-exposure prophylaxis (PrEP) is a suite of biomedical approaches to prevent HIV infection. Latinx MSM are less likely to take PrEP compared to non-Latinx White MSM. This qualitative study identified interpersonal- and community-level barriers and facilitators of PrEP among young adult Latinx MSM. Using stratified purposeful sampling, 27 Latinx men, ages 19-29 years and living in a US-Mexico border region, completed self-report demographic surveys and participated in semi-structured in-depth interviews assessing barriers and facilitators to PrEP. Directed content analysis was used to identify both a priori and emerging themes. Most participants reported that other people, including peers, friends, partners, and health care providers were both supportive and discouraging of PrEP use. Participants' intersectional identities as members of both Latinx and LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer) communities both hindered and facilitated PrEP use.

Gay Community Involvement and Condomless Anal Sex Among Sexual Minority Men in the USA.

Sexual minority men (SMM) remain disproportionately burdened by sexually transmitted infections. Although gay community involvement has been theorized to be protective against many negative health outcomes, research examining the association between community involvement and condomless anal sex (CAS) has yielded conflicting results. The current study, conducted between 2018-2020, examined whether the importance one places on various aspects of community involvement was associated with CAS among a sample of young adult SMM aged 18-34 years with body image concerns (N = 180). Gay community involvement was measured using the Importance of Gay Community Scale, and the results of an exploratory factor analysis indicated the presence of two factors: "social activism" and "going out/nightlife." A zero-inflated Poisson regression was conducted to examine the association between gay "social activism," "going out/nightlife," and their interaction with the number of CAS partners. Upon examining a significant interaction, "social activism" had a protective effect against CAS at low levels of "going out/nightlife," but this effect was non-significant at higher levels. These results suggest that encouraging gay community involvement through activism could be effective at reducing CAS and addressing the health disparity that exists within this population.

Demographic and sociocultural predictors of sexuality-related body image and sexual frequency: The U.S. Body Project I.

Body image is a critical component of an individual's sexual experiences. This makes it critical to identify demographic and sociocultural correlates of sexuality-related body image: the subjective feelings, cognitions, and evaluations related to one's body in the context of sexual experience. We examined how sexuality-related body image differed by gender, sexual orientation, race, age, and BMI. Four items assessing sexuality-related body image were completed by 11,620 U.S. adults: self-perceived sex appeal of their body, nude appearance satisfaction, and the extent to which they believed that body image positively or negatively affected their sexual enjoyment and feelings of sexual acceptability as a partner. Men reported slightly less nude appearance dissatisfaction and fewer negative effects of body image on sexual enjoyment and sexual acceptability than women, but did not differ in reported sex appeal. Poorer sexuality-related body image was reported by people with higher BMIs, not in relationships, who had sex less frequently, among White compared to Black women and men, and among gay compared to heterosexual men. Data also revealed a subgroup of respondents who reported that their body image had a positive impact on their sex lives. The findings highlight a need for interventions addressing sexuality-related body image.

Suicidality, Sexual Orientation, and Race/Ethnicity: Results from a U.S. Representative Adolescent Sample.

Objective: We examined sadness/hopelessness and suicide among racial/ethnic and sexual minority youth (SMY).Methods: 2017 Youth Risk Behavior Survey (YRBS) data on sadness/hopelessness and suicide were analyzed among White, Black, and Hispanic/Latino youth.Results: A main effect of sexual minority (SM) identity emerged for sadness/hopelessness, suicidal ideation, suicide plan, suicide attempts, and injurious attempts; SMY reported increased risk compared to their heterosexual peers. An interaction between Black race and SM identity emerged for sadness/hopelessness, suicidal ideation, and suicide plan; White SMY were at greater risk than Black SMY. A main effect of Black race on suicide attempts was found; Black youth reported increased risk of suicide attempts compared to White youth.Conclusions: Black SMY exhibited lower risk of sadness/hopelessness, suicide ideation, and suicide plans than their White SMY peers, whereas Black youth overall were more likely to report suicide attempts than their White peers.HIGHLIGHTSThere was an interaction of sexual minority identity and race (Black or White) for three outcomes.SM and Black identities were associated with higher risk for suicide attempts.Only SM identity was associated with increased risk of injurious suicide attempts.

Pilot randomised controlled trial of a patient navigation intervention to enhance engagement in the PrEP continuum among young Latino MSM: a protocol paper.

INTRODUCTION: Men who have sex with men (MSM) are one of the most at-risk group for contracting HIV in the USA. However, the HIV epidemic impacts some groups of MSM disproportionately. Latino MSM comprise 25.1% of new HIV infections among MSM between the ages of 13 and 29 years. The daily medication tenofovir/emtricitabine was approved by the Food and Drug Administration for pre-exposure prophylaxis (PrEP) in 2012 and has demonstrated strong efficacy in reducing HIV acquisition. METHODS AND ANALYSIS: Through extensive formative research, this study uses a pilot randomised controlled trial design and will examine the feasibility and acceptability of a patient navigation intervention designed to address multiple barriers to improve engagement in the PrEP continuum among 60 Latino MSM between the ages of 18 and 29 years. The patient navigation intervention will be compared with usual care plus written information to evaluate the feasibility and acceptability of the intervention and study methods and the intervention's potential in improving PrEP continuum behaviours. The results will be reviewed for preparation for a future full-scale efficacy trial. ETHICS AND DISSEMINATION: This study was approved by the institutional review board at San Diego State University and is registered at ClinicalTrials.gov. The intervention development process, plan and the results of this study will be shared through peer-reviewed journal publications, conference presentations and healthcare system and community presentations. REGISTRATION DETAILS: Registered under the National Institutes of Health's ClinicalTrials.gov (NCT04048382) on 7 August 2019 and approved by the San Diego State University (HS-2017-0187) institutional review board. This study began on 5 August 2019 and is estimated to continue through 31 March 2021. The clinical trial is in the pre-results stage.

Intimate partner violence and muscularity-building behavior in latino sexual minority men.

Intimate partner violence (IPV) has been associated with increased prevalence of eating disorders. In men, disordered eating is often related to the muscularized ideal. Sexual minority men (SMM; e.g., gay, bisexual, etc.) are at higher risk for eating disorders and Latino SMM may be at particularly high risk; however, IPV and eating pathology has yet to be examined in this population. Therefore, the aim of this study is to elucidate the association between IPV and muscularity-related dissatisfaction and muscularity-oriented behavior in Latino SMM. Participants were 81 Latino SMM. Thirty participants (37% of the sample) met the cutoff score for experiencing IPV in the past month. In bivariate analyses, IPV was associated with muscularity-oriented behavior, but not muscularity-related dissatisfaction. In multivariable analyses, IPV was negatively associated with muscularity-related dissatisfaction with a small effect size and positively associated with muscularity-oriented behavior with a large effect size. It may be that SMM engage in muscle building behavior to increase self-esteem, regulate affect, or better physically protect themselves from their abusive partner. Future research should investigate motivation for muscle building behavior in individuals experiencing IPV.

Traditional Machismo, Caballerismo, and the Pre-Exposure Prophylaxis (PrEP) Cascade Among a Sample of Latino Sexual Minority Men.

Between 2010 and 2017, HIV diagnoses increased 17% among Latino sexual minority men (SMM) while decreasing 19% among White SMM and stabilizing among African American SMM. Traditional machismo is characterized by aggressiveness/power; caballerismo consists of family values/chivalry. Latino SMM high in traditional machismo may avoid seeking Pre-Exposure Prophylaxis (PrEP) to prevent being stigmatized as effeminate. Latino SMM high in caballerismo may be more likely to use PrEP to remain healthy for their family and/or partners. The current study explored the association between traditional machismo and caballerismo with four steps of the PrEP cascade. Participants were 151 HIV-negative/unknown Latino SMM living in San Diego, California (M = 24.18 years old) who completed an online study. Traditional machismo was associated with low odds of PrEP awareness, willingness, and adherence and high odds of PrEP use. Caballerismo was associated with greater odds of PrEP awareness, willingness, use, and adherence. High levels of traditional machismo among Latino SMM may be a barrier to PrEP. Caballerismo may be a facilitator of PrEP awareness, willingness, use, and adherence. Programs which serve to move Latino SMM through the PrEP cascade may benefit from discussing culturally-relevant masculinity given the potential for their differential associations with PrEP variables.

The role of sexual minority stress and community involvement on disordered eating, dysmorphic concerns and appearance- and performance-enhancing drug misuse.

Prior research has established that sexual minority (SM) individuals are more likely to experience disordered body image behaviors and concerns than heterosexual individuals. This increased risk may be explained by minority stress theory - that SM individuals are subject to SM-specific stressors, leading to health disparities - but this has not yet been fully examined. Furthermore, this theory states that SM community involvement may mitigate negative outcomes. The current study examines whether minority stress is associated with screening positive for an eating disorder, screening positive for body dysmorphic disorder, and appearance- and performance-enhancing drug misuse in a sample of SM individuals (483 women and 479 men) in the US. This study also examines whether the effect of minority stress is moderated by SM community involvement. Logistic regressions were conducted for each type of minority stress (internalized homophobia, sexual orientation concealment, and heterosexist discrimination) interacting with community involvement. After correction for multiple comparisons, all minority stressors and community involvement were positively associated with increased odds of disordered body image behaviors and concerns, with no evidence of a buffering effect for community involvement. The lack of a buffering effect is contrary to minority stress theory and may inform future prevention efforts.

Self-Efficacy in Researching and Obtaining Medical Cannabis by Patients With Chronic Conditions.

Background. Due to the increasing availability of medical-grade cannabis for treatment of chronic conditions, we examined how prospective users navigate the process of researching, procuring, and using cannabis. Given the barriers prospective users experience, self-efficacy may be a factor for those who incorporate cannabis into treatment. Aims. The purpose of this study was to identify behaviors associated with self-efficacy in the context of researching, procuring, and using cannabis. We analyzed narratives of patients who obtained legal medical cannabis in the currently complex medical, legal, and social landscape. Method. Data were collected through 30 telephone interviews utilizing a semistructured interview protocol, which were analyzed using inductive coding. The protocol emphasized four topics: (a) symptom management/pain reduction, (b) provider communication about chronic conditions/cannabis, (c) perspectives on medicinal cannabis and stigma, and (d) views on recreational cannabis. Results. Participants demonstrated self-efficacy in three contexts: (a) self-directed experimentation with cannabis strains, dosages, and administration methods; (b) managing care by selecting and educating their providers; and (c) information-seeking and research behaviors. Discussion. High self-efficacy may be an important factor in navigating the medical cannabis process. Results suggest that providers who are not prepared to partner with patients as they seek information about medical cannabis may be replaced by dispensaries and websites with expertise in cannabis but without understanding of patients' medical conditions and individual needs. Conclusion. Patients with higher self-efficacy may engage in various activities to investigate, procure, experiment with, and incorporate medical cannabis into their condition management outside the purview of their providers.

Syndemics and the PrEP Cascade: Results from a Sample of Young Latino Men Who Have Sex with Men.

Young Latino men who have sex with men (MSM) are a highly vulnerable population for HIV infection. Pre-exposure prophylaxis (PrEP) is a novel biomedical HIV prevention tool that may aid in reducing the disparity in HIV incidence among Latino MSM. However, PrEP use is disproportionally low among Latino MSM and, therefore, identifying barriers along the PrEP continuum of care (the "PrEP cascade") would provide insight into how to best deploy PrEP interventions. Syndemics theory is a prominent framework employed in HIV prevention; however, to date, no known studies have applied this theory to PrEP. Thus, the aim of the current study was to explore the association between syndemics and the PrEP cascade, including the degree to which psychosocial and structural syndemic constructs are related to the PrEP cascade. Participants were 151 young Latino MSM (M age = 24 years; SD = 3) residing in San Diego, California, who completed a battery of online self-report measures. Results indicated high levels of syndemic indicators and varying levels of engagement across the PrEP cascade. As syndemic indicators increased, the odds of engagement across the PrEP cascade were significantly lowered. Psychosocial and structural syndemic factors accounted for unique variance in the PrEP cascade. Results highlight the need for combination interventions that address both psychosocial and structural barriers to PrEP use and persistence among young Latino MSM.

Machismo and anabolic steroid misuse among young Latino sexual minority men.

Latino sexual minority men (SMM) have elevated anabolic-androgenic steroid (AAS) misuse in comparison to their heterosexual and non-Latino peers. Within a gender role framework, desire to present as masculine through heightened muscularity may be related to increased AAS misuse. To assess the association between AAS misuse and a culturally-distinct masculinity, this study examined the relationship of two aspects of machismo, traditional machismo and caballerismo, with AAS misuse in the past month. Participants were 141 young adult Latino SMM recruited from the San Diego area. Participants completed a self-report questionnaire online in English or Spanish, which included measures of machismo and AAS misuse. Out of 141 participants, 27 reported AAS misuse (19.1%). Traditional machismo was positively associated with AAS misuse and caballerismo was negatively associated with AAS misuse. Traditional machismo, which emphasizes dominance, may be positively associated with AAS misuse due to its facilitation of muscle development, which could enable physical intimidation; greater musculature may also counteract assumptions about femininity and sexual orientation. Caballerismo may be negatively associated with AAS by providing a flexible masculinity model that emphasizes social cohesion over dominance. Future AAS misuse interventions could include values-based work and cognitive restructuring of masculinity schemas.

The associations between subdimensions of religiosity and illicit substance use among latino sexual minority men.

BACKGROUND: Latino sexual minority men (SMM) may be a group disproportionately at risk for substance use than heterosexual Latino men and non-Latino SMM. As religiosity may be a culturally relevant factor, the current study aimed to explore the association of three subcomponents of religiosity: organizational religious activity (ORA; i.e., public religious activity), non-organizational religious activity (NORA; i.e., private religious activity), and intrinsic religiosity (IR; i.e., personal commitment to one's religion) in predicting illicit substance use. METHOD: Participants were 151 Latino SMM recruited from San Diego County (M = 24.18 years of age, SD = 3.19), who completed online self-report questionnaires in English or Spanish. Binary outcome variables represented use of illicit substances in the past month vs. no use. Religiosity was assessed using the three subscales (ORA, NORA, and IR) of the Duke University Religion Index (DUREL). Acculturation was controlled for using the Bidimensional Acculturation Scale for Hispanics. RESULTS: ORA was associated with opiates (OR = 1.53, p = .04). NORA was associated with cocaine (OR = 1.69, p = .01), opiates (OR = 1.56, p = .04), amphetamines (OR = 1.67, p = .02), and sedatives (OR = 2.33, p = .001). IR was associated with amphetamines (OR = 1.34, p = .03). CONCLUSION: NORA is positively associated with multiple illicit substances, and may represent greater internalization of anti-gay religious doctrines compared to other components of religiosity in Latino SMM. An intersectional approach addressing religious and sexual minority identity may be useful in substance use treatment for Latino SMM.

Body image and condomless anal sex among Young Latino sexual minority men.

OBJECTIVE: To investigate body image and condomless anal sex (CAS) among young Latino sexual minority men (SMM)-a population with health disparities in HIV and body image concerns. METHODS: Participants were 151 young Latino SMM from the San Diego area who were HIV-negative or unknown. Participants completed a questionnaire online in either English or Spanish, which included body image and sexual behavior items. A binary CAS variable was created based on the number of CAS partners reported (0 vs 1 + over past 3 months). A logistic regression was conducted with body dissatisfaction, appearance investment, and their interaction term entered as predictor variables and CAS as the outcome. RESULTS: Of 151 participants, 54 (35.8%) reported no CAS in the past 3 months. Appearance investment, but not body dissatisfaction, was associated with higher odds of CAS. However, a significant interaction indicated that body dissatisfaction was associated with higher odds of CAS when appearance investment was high. CONCLUSIONS: Young Latino SMM who are highly invested in, and dissatisfied with, their appearance may be at significantly increased risk for acquiring HIV through elevated odds of CAS. Reducing appearance concerns in this population may lead to reductions in HIV risk behaviors.

Preferences for Medical Marijuana over Prescription Medications Among Persons Living with Chronic Conditions: Alternative, Complementary, and Tapering Uses.

OBJECTIVES: Despite expanded legalization and utilization of medical cannabis (MC) internationally, there is a lack of patient-centered data on how MC is used by persons living with chronic conditions in tandem with or instead of prescription medications. This study describes approaches to use of MC vis-à-vis prescription medications in the treatment of selected chronic conditions. DESIGN: Participants completed semistructured telephone interviews with open-ended questions. Content analysis of qualitative data identified themes and subthemes relating to patient approaches to using MC products. PARTICIPANTS: Thirty persons (mean age = 44.6 years) living with a range of chronic conditions (e.g., rheumatoid arthritis, Crohn's disease, spinal cord injury/disease, and cancer) who had qualified for and used MC in Illinois. RESULTS: Participants described a range of approaches to using MC, including (1) as alternatives to using prescription or over-the-counter medications; (2) complementary use with prescription medications; and (3) as a means for tapering off prescription medications. Motives reported for reducing or eliminating prescription medications included concerns regarding toxicity, dependence, and tolerance, and perceptions that MC improves management of certain symptoms and has quicker action and longer lasting effects. CONCLUSIONS: MC appears to serve as both a complementary method for symptom management and treatment of medication side-effects associated with certain chronic conditions, and as an alternative method for treatment of pain, seizures, and inflammation in this population. Additional patient-centered research is needed to identify specific dosing patterns of MC products associated with symptom alleviation and produce longitudinal data assessing chronic disease outcomes with MC use.

Risk behaviours of an interrelated syphilis-infected sexual network of men who have sex with men.

AIMS AND OBJECTIVES: We examined the risk behaviours in an interrelated sexual network of 33 syphilis-infected men who have sex with men on the use of condoms, substances and websites to meet sexual partners. Our study used a descriptive exploratory design to investigate co-occurring high-risk behaviours in this interrelated sexual network to inform future health interventions and research directions. BACKGROUND: Although the risk behaviours for human immunodeficiency virus transmission in men who have sex with men have been studied, few have studied the high-risk population of men who already have syphilis, and even fewer have studied the risk behaviours in sexual networks of syphilis-infected men who have sex with men who were identified using contact tracing. DESIGN/METHODS: The data were collected from semi-structured, individual interviews at a not-for-profit lesbian, gay, bisexual and transgender health centre in a large city in the Midwestern USA. RESULTS: Inconsistent condom use was substantial during both insertive (92%) and receptive (88%) anal intercourse. Most participants (97%) reported using one or more substances prior to or during anal intercourse, and Internet websites were the most common place to meet sexual partners (88%). CONCLUSIONS: High-risk behaviours were significant within this syphilis-infected sexual network of men who have sex with men. The majority of our 33 participants were non-Hispanic Whites (n = 27, 82%), possessed a baccalaureate degree or higher (n = 23, 70%), and actively sought out unprotected anal intercourse [21 participants (64%) used BareBackRT.com, a website to seek out unprotected anal intercourse]. RELEVANCE TO CLINICAL PRACTICE: Nurses should be more informed about the risk factors of a high-risk sexual network of syphilis-infected men who have sex with men. Interrelated sexual networks have high levels of similarity among participants' high-risk behaviours; contact tracing may be used to identify individual participants for relevant risk-reduction interventions.

Cardiovascular disease risk management for Aboriginal and Torres Strait Islander peoples in primary health care settings: findings from the Kanyini Audit.

OBJECTIVE: To describe cardiovascular disease (CVD) risk management in Indigenous primary health care. DESIGN, SETTING AND PARTICIPANTS: Review of 1165 randomly selected case records of Indigenous Australian adults, aged >/= 18 years, regularly attending eight health services in diverse settings in New South Wales, Queensland and Central Australia, October 2007 - May 2008. MAIN OUTCOME MEASURE: Adherence to CVD risk screening and management guidelines, especially with respect to overall or absolute CVD risk. RESULTS: More than half the people in the sample (53%) were not adequately screened for CVD risk according to national recommendations. Underscreening was significantly associated with younger age, less frequent attendance, and lower uptake of the Medicare Health Assessment. Of the sample, 9% had established CVD, and 29% of those aged >/= 30 years were classified as high risk according to the 2004 National Heart Foundation of Australia (NHFA) adjusted Framingham equation. Of those with CVD, 40% (95% CI, 30%-50%) were not prescribed a combination of blood pressure (BP) medicines, statins and antiplatelet agents, and 56% (95% CI, 49%-62%) of high-risk individuals without CVD were not prescribed BP medicines and statins. For high-risk individuals not prescribed BP medicines or statins, 74% (95% CI, 64%-84%) and 30% (95% CI, 23%-39%) respectively, did not meet 2004 NHFA criteria for prescribing of these medications, and of those already prescribed BP medicines or statins, 41% (95% CI, 36%-47%) and 59% (95% CI, 52%-66%) did not meet respective guideline targets. CONCLUSIONS: These management gaps are similar to those found in non-Indigenous health care settings, suggesting deficiencies across the health system. Prescribing guidelines which exclude many high-risk individuals contribute to suboptimal management. Guideline reform and improved health service capacity could substantially improve Indigenous vascular health.